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Endoscopic Sinus Surgery
Please read the following information carefully and completely. Afterwards, our staff will be happy to answer all of your questions.
What is Endoscopic Sinus Surgery?
Sometimes abbreviated as ESS or FESS (for Functional Endoscopic Sinus Surgery), this procedure opens the sinuses and allows them to drain. The surgeon uses an “endoscope” to see into the sinuses, similar to the one used during your pre-operative evaluation. The endoscope utilizes fiberoptic glass rods to provide superb visualization during the surgery. This allows the surgeon to precisely open the sinus drainage pathways wider while leaving the remaining tissue undisturbed. The surgeon passes specialized instruments alongside the narrow scope into the nose to perform the necessary procedures.
The majority of individuals have four sets of sinuses on each side: maxillary (under the eyes), ethmoid (between the eyes), frontal (above the eyes), and sphenoid (behind the nose). Sinusitis may affect some or all of these sinuses. Based on your symptoms, examination, and CT scan, your surgeon will determine which sinuses will need to be opened. Occasionally during the surgery, additional inflammation or infection is discovered and may necessitate opening more sinuses.
What are the benefits of surgery?
The goal of endoscopic sinus surgery is to improve the drainage of the sinuses and prevent mucus from building up in these chambers. When secretions accumulate in a blocked off sinus, they may become infected with bacteria and result in a flare up of sinus symptoms. By widening the natural drainage pathways of the sinuses, surgery helps to decrease the frequency, severity, and duration of infections.
It is important to understand that surgery is not a cure for sinusitis. In most patients with sinusitis, the lining of the nose and sinuses (the “mucosa”) overreacts to irritants, swells, and causes accumulation of mucus. Sinus surgery does not directly treat this over-reactive lining, but instead drains the sinuses and allows the mucosa to improve on its own. However, due to allergy or irritant stimulation, the lining may remain inflamed after surgery. Medications such as nasal sprays and antihistamines may remain essential after surgery. If you are receiving allergy shots, these would also continue after surgery.
Opening the sinus cavities more widely allows the spray medications to get into the sinuses and directly act on all of the mucosa. It also promotes drainage of mucus so that irritants are removed from the nose. Surgery, therefore, acts with medications to improve the lining and keep the sinuses healthy. It is an adjunct to, not a replacement for, proper medical management.
What are the risks?
Surgery, like all events in life, has some risks. Your surgeon has spent years developing his technique to minimize these risks. Nevertheless, you should be aware of the potential risks of the surgery so you can make an informed decision.
All surgeries carry with them the risks of bleeding, infection, and pain. The risk of bleeding is increased by certain medications so you should review all medications (prescription, over-the-counter, and herbal) with your physician prior to surgery. Aspirin must be stopped at least 10 days prior to surgery and other anti-inflammatory medications such as ibuprofen (Motrin®, Advil®, etc.) must also be stopped at least 10 days prior to surgery. We typically do not place nasal packing that needs to be removed. However, if there is excessive oozing at surgery, you may have small nasal sponges placed at the conclusion of the procedure. Due to the small size of the sponges, most patients do not have difficulty breathing through their noses while they are in place. The sponges are usually removed within 1-2 days. Rarely, excessive bleeding forces termination of the procedure and in extremely rare cases, blood transfusion may be required. If a transfusion is necessary, it would carry the risk of transfusion reaction as well as transmission of blood-borne disease.
The risk of infection will be minimized by taking antibiotics after the procedure. The length of antibiotic treatment is individualized based on endoscopic findings but usually lasts 2-4 weeks. Most patient’s pain is relieved by Extra Strength Tylenol® or a mild narcotic and Tylenol® combination. You will receive a prescription for sufficient pain medicine after your surgery.
Some scar tissue develops after any surgery, but if it is excessive it may obstruct the newly opened sinuses. You should expect to visit your surgeon multiple times during the initial post-operative period. This post-operative care is critical to the success of the surgery and usually entails visits every week or every other week for four to six weeks. During these visits, your nose will be thoroughly examined to be sure it is healing properly and that excessive scarring is not developing. Sometimes it is necessary to remove a small amount of scar tissue under local anesthesia.
Some temporary swelling or bruising around the eye rarely occurs after surgery. Tears may run from the eye for a few days after surgery. This is usually temporary but in rare cases may persist. If so, this condition can typically be corrected with minor surgery.
Due to the proximity of the sinuses to the eyes and to the brain, sinus operations include risks to these structures. This includes double vision or loss of vision as well as brain injury or leakage of spinal fluid, which could lead to meningitis. Fortunately these risks are extremely rare. If spinal fluid leakage were to occur, it would require additional hospitalization and may necessitate another operation to close the leak.
In some cases it is necessary to straighten the nasal septum in order to gain access to the sinuses or to improve breathing through the nose. This procedure, called a septoplasty, carries with it the additional risks of a permanent hole in the septum (septal perforation). Rarely septoplasty can change the appearance of the nose or cause permanent numbness of the front top teeth.
Nasal surgery, in rare cases, can also lead to loss of the sense of smell.
Lack of improvement or even worsening of the underlying condition and the need for re-operation are other risks inherent with any surgery. Surgery also carries with it risks of anesthesia. Endoscopic sinus surgery is typically performed under general anesthesia, meaning you are totally asleep and have no memory of surgery or pain during surgery.
What should I expect after surgery?
You will want to take it easy for the first few days and then return to normal activities over the next week.
Most patients take a week off of work/school following the surgery. Depending on the individual and the how extensive the surgery was, more or less time off may be necessary. You can expect some nasal stuffiness for the first 3-4 days after surgery as well as occasional bloody mucus discharge from your nose. You can travel by air two days after the surgery but cannot swim for 4-6 weeks following the procedure.
You will receive a complete list of instructions following surgery.
What are the alternatives?
Continuing with medical therapy alone and avoiding surgery is always an alternative. Additionally, other types of sinus surgeries exist and you may wish to speak with your surgeon about them. As with any surgery, you should feel comfortable seeking a second opinion from another surgeon.
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